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Surgical Management of Pancreatic Neuroendocrine Tumors

Tanaz Vaghaiwalla1, Xavier M Keutgen1

  • 1Department of Surgery, Division of General Surgery and Surgical Oncology, Endocrine Research Program, University of Chicago Medicine, 5841 South Maryland Avenue, MC4052, Chicago, IL 60637, USA.

Surgical Oncology Clinics of North America
|March 11, 2020
PubMed

Insights

Surgical approaches for pancreatic neuroendocrine tumors (PNETS) vary based on tumor characteristics and patient factors. Management strategies range from observation to aggressive resection, with options for localized and metastatic disease.

Area of Science:

  • Oncology
  • Surgical Gastroenterology
  • Endocrinology

Background:

  • Pancreatic neuroendocrine tumors (PNETS) management is evolving.
  • Treatment decisions are influenced by tumor type (sporadic vs. hereditary) and function.
  • Metastatic PNETs, particularly to the liver, present unique challenges.

Purpose of the Study:

  • To outline current surgical management strategies for pancreatic neuroendocrine tumors.
  • To discuss factors influencing treatment decisions for PNETs.
  • To review options for managing PNET liver metastases.

Main Methods:

  • Review of current surgical practices for PNETs.
  • Analysis of factors guiding PNET management.
  • Discussion of surgical resection techniques (enucleation, distal pancreatectomy, pancreaticoduodenectomy).
  • Overview of treatment modalities for hepatic metastases.

Main Results:

  • Sporadic PNETs are managed more aggressively than hereditary ones.
  • Functioning PNETs are typically resected unless metastatic.
  • Localized nonfunctioning PNETs < 2 cm may be observed.
  • PNETs > 2 cm require parenchymal-sparing or formal anatomic resection.
  • Hepatic metastases are common and have available treatment options.

Conclusions:

  • Surgical management of PNETs is tailored to individual tumor and patient profiles.
  • A range of surgical techniques are available for localized PNETs.
  • Effective systemic and liver-directed therapies exist for PNET liver metastases.
Keywords:
Hepatic metastasesLiver debulking surgeryPancreatic neuroendocrine tumorPrimary tumor resection

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